42 YEAR OLD WOMEN WITH MULTIPLE HEALTH EVENTS SINCE BIRTH
P.NIKHITHA
roll no. 130
I have been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history coma clinical findings, investigations and come up with the diagnosis and treatment plan.
Following is my analysis of this patients problem:
Problems in priority:
1.numbness in left hand and foot and feeling like someone was pouring ice water over the cheek.
2. Anorexia
3. Swelling of face abdomen and head
4. Migraine attacks and Aura
5. Spinning when she turn left
6. Sleeplessness
7. Severity of breathing during exercise
8. Memory loss
9. Frequent infections.
AND THE REASONS FOR FEW OF THE PROBLEMS COULD BE:
Frontal bossing:
Frontal bossing might be due to severe anaemia (G6PD deficiency) that cause increased, but ineffective production of red blood cells by the bone marrow.
Jaundice after birth
--G6PD deficiency.
Insomnia
**G6PD deficiency causes impairment in serotonin levels
**Onset -since birth
**Duration of sleep 2-4 hours, are REM sleep
Tongue tie ankyloglossia
**Cause is largely unknown
**Many cases have been associated with genetic factors. So here there is no sufficient family history to say if its been in her family
**Breastfeeding problems:
Tongue tie >>> baby might chew instead of suck causing significant nipple pain >>> baby's inability to get breast milk causing:
#intestinal tissue damage [necrotizing enterocolitis
#effects cognitive development
#Inadequate nutrition and failure to thrive leading to [Infectious morbidity ,pneumonia]
Migrane-aura
**Hypersensitive brain ---->sensory threshold is less to have headache.
** Electrical movement transfers from occipital lobe to frontal lobe slowly 3-4mm/hour.
||
Causing disruption of network-->vasodilation
**As she has aura, it indicates affected occipital lobe.[while affected temporal lobe causes nausea and vomiting and affected frontal lobe causes psychic aura]
causes of daily and weekly weight fluctuations
**It's usually the result of food (flava beens) and water intake
**Water retention due to excess salt (2-4 spoons of salt per day)
**retention of urine and stool also can cause rate fluctuation
**certain medications can cause people to gain weight rapidly like drugs which treat depression and psychiatric disorders
**Metabolism slowing down with age
**Stress, depression or anxiety
**Lack of sleep
**Due to nicotine withdrawal
**G6PD deficiency.
Memory loss or dementia and weakness of limbs and face
Cause for this is yet to be diagnosed (I didn't find sufficient data to find reason for motor weakness)
**Genetic cause might be the reason as her mother suffered with fibromyalgia.
PCOS
**It is associated with ectopic pregnancy
**Potential causes are altered endometrial environment and subsequent reduction in implant success due to concurrent hyperandrogenism
**This might be the reason for hair loss on scalp, high blood cholesterol.
**androgen disorders cannot be cure but they can be treated usually with medications like oral contraceptives pills.
BPPV[Benign paroxysmal positional vertigo]
This might be the cause for "spinning on turing left"
Fatty liver
**I highly suspect fatty liver in this patient.
**Without good nutritional detoxification liver overload will only result in toxins being pushed back into the blood. Leading to
#longterm fatigue
#memory impairment(rarely)
#immune dysfunction
#continued weight gain
The following are due to hyperandrogenism in this patient:
#more hair growth at the age of 3 years
#mood disorders
#ectopic pregnancy
#PCOD
FAMILY HISTORY
**Both parents were chainsmokers
**Mother was diagnosed for fibromyalgia which may raise fibromyalgia in our patient
**Father had a heart attack at the age of 40
**Grandfather had an early death due to some cardiac issues
**Grandmother had an issue of waking up during the surgery which also is seen in our patient.
CURRENT DRUG TREATMENT
**L-serine 20 grams at night
**Ribose to grams every hour in water ok, if any major exercise or exertion
**400 milligrams of cimetidine
**600 milligrams of n acetylcysteine
**Iron folate 500% of RDA
INVESTIGATIONS
ADVICE: advanced diagnostic modality like whole genome sequencing must be done.
TREATMENT PLAN
**AS IT IS INTEGRATION OF MANY DISORDERS,INVOLVING MANY ORGANS AND MOREOVER IT IS A GENETIC DISORDER SO THERE IS NO CURE AND TREATMENT OF SYMPTOMS CAN BE DONE
**Reduce salt intake comma as it might cause long-term problems due to vasoconstriction.
**Use centre done for swelling
**Continue l-serine and cimetidine for sleep
**Continue to take triptans coma ribose and iron folic acid supplements
**Cut oxidative stress
**Avoid beans
**Eat an apple a day as she feels healthy
**Antioxidant supplement pycnogenol
**Cognitive therapy
**Yoga--events cardiac problems
**Take sufficient rest
**Physiotherapy which improves muscle power
**Multi vitamin tablets
CAUTION:
As she is diagnosed with few diseases and many we are yet to be diagnosed so I advise her not to take many drugs or try new drugs and other eatables as the may cause food-drug interactions or drug-drug interactions.
